Health care found to be better with online help

By CHERIE BLACK
http://seattlepi.nwsource.com

Even though his doctor told him what to do to lower his high blood pressure, John Mason had trouble doing it.

Watching a diet and exercising regularly isn’t easy for anyone, he said, so for five years he lived with hypertension.

But as the Burien man approached 50 — the same age his father, aunt and cousin died of heart disease — he began taking his blood pressure seriously.

In 2006, he enrolled in a first-of-its-kind clinical trial to check whether monitoring blood pressure at home and having regular contact with a health care provider through the Internet helped patients lower their blood pressure.

The Seattle-based study, which began in 2006, showed patients with online help controlled their high blood pressure more than twice as well as those who didn’t have extra resources, and they did it with fewer doctor visits.

The study, published in Wednesday’s Journal of the American Medical Association, involved 778 Group Health patients with uncontrolled high blood pressure.

The eligible patients — who needed Internet access to participate in the nearly three-year study — were randomly assigned to one of three groups to see which resources better helped them control their blood pressure.

One group got standard care, which included blood pressure pamphlets and access to doctor e-mail and Group Health’s Web site.

The second group got blood-pressure monitors and also had access to the Web, but were trained in how to navigate the site and shown how to send blood pressure results to their doctors online.

The third group, which Mason was in, got home blood-pressure monitors and Web training, but also got care from pharmacists online, usually about every two weeks.

Mason tracked his blood pressure and exchanged e-mails with pharmacists about twice a month. They reminded him when to send in his blood-pressure readings and developed lifestyle goals for him to follow. They also adjusted medication doses as needed — all via e-mail.Web-based care nearly doubled the percentage of people whose blood pressure was controlled, said Dr. Beverly Green, a Group Health family doctor and lead researcher of the study. It nearly tripled for those with the highest blood pressure, she said.

Nearly 60 percent of patients in the pharmacist group controlled their high blood pressure, which means their average reading was below 140/90. That compared with 31 percent in the standard-care group and 36 percent in the second group.

“Hypertension is one of the most common reasons for a clinic visit, and we don’t manage it very well,” Green said. “You’re dealing with a packed day and even if a patient comes in with high blood pressure, it may not be the main reason for the visit and can get overlooked.

“We don’t have a superpill for high blood pressure like we do for cholesterol, which is hard for a patient,” she said.

Allowing patients to be anywhere in the world and still have direct access to information and their physician is empowering, Green said, but she fears the nation’s current health care system isn’t conducive to online visits.

Doctors are reimbursed by how many visits they have — not how many e-mails they send, she said.

But some Seattle-area physicians see the landmark study as a step in the right direction.

“This answers some of our questions about the safest ways to join the patient in a care team that improves blood pressure control,” said Dr. Kim Pittenger, a family doctor at Virginia Mason Kirkland.

“We assume and hope that improved control will prevent heart disease and stroke,” she said. “Most of what we know about planning out care with patients tells us they get better results the more confident they are and the more we entrust patients with targeted self-care. It’s not all about visiting the doctor all of the time.”

Swedish Medical Center is scheduled to launch a “telehealth” service in mid-July to help home-care patients monitor chronic health problems. Though high blood pressure isn’t one of the initial five categories available for monitoring, which includes diabetes and congestive heart failure, Swedish said the program helps the hospital intervene before a medical crisis is full-blown.

Mason, now 53, has significantly lowered his blood pressure.

Though he didn’t know exactly how many points he’s dropped, his doctor is pleased with the results. Since completing the study, Mason is creating his own goals and finding it easier to eat healthy and exercise. And his wife and nine children don’t worry about him as much.

“As a man, you don’t go to the doctor until you have to,” he said. “With the study, the greatest thing in the world was to have the pharmacist available to me online. I had goals I had to reach, and it was helping me develop good habits.

“That human contact helped.”

P-I reporter Cherie Black can be reached at 206-448-8180 or cherieblack@seattlepi.com. Read her To Your Health blog at blog.seattlepi.com/toyourhealth.

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